This article by Jazmin Orozco was first published in Kaiser Health News, reprinted with permission
November 18, 2022
ELKO, Nev. – When Elko County commissioners rejected a $500,000 grant from the Centers for Disease Control and Prevention that could have helped the county create a health department or health district, Kayla Hopkins begged them to reconsider.
Hopkins, who has lived for nearly nine years in the vast rural county that makes up Nevada’s northeast corner, told the board how she struggled with postpartum depression and needed mental health resources.
“I wasn’t able to get the help I needed,” Hopkins said during a public meeting in late 2021, adding that she fell into what could be considered a mental breakdown. She said she was airlifted more than 300 miles away to Carson City, where she received care in a psychiatric facility for 10 days.
“I was away from my family,” Hopkins said. “I was away from my support system here and I still struggle with mental health and I still can’t get the help I need because we just don’t have it here.”
Pleas from Hopkins and others were not enough to sway the elected commissioners. Nor did 11 letters from local health leaders urging the board to receive the infusion of public health funds. Four of the five county commissioners, citing concerns about government overreach and their lack of trust in federal agencies, voted against pursuing the grant. Nearly a year later, with the pandemic heading into its third year and the arrival of monkeypox, the county is still without a public health department to respond.
And the same distrust of agencies that administer public health grants continues elsewhere.
Elko County, home to about 54,000 people, was not alone in rejecting federal aid aimed at strengthening public health last year. Experts say they were surprised and concerned to see the rare local or state leader, swayed by political partisanship, reject funding opportunities for historically limited public health systems.
As many Tory leaders and their constituents railed against measures aimed at combating Covid-19 — things like mask policies and vaccine promotions — the pandemic revealed long cracks in the nation’s public health infrastructure, particularly in rural and underserved communities.
“Partisan politics has poisoned the well to the point where we are willing to sacrifice the health of our citizens,” said Brian Castrucci, president and CEO of the de Beaumont Foundation, a national nonprofit that advocates for public health policy. “Is the political position worth it?”
Over the past two years, officials in Idaho, Iowa, and New Hampshire rejected Covid relief money, their decisions often accompanied by political statements about overreaching the federal government. And officials representing local governments across the country, including PIMA and Pinal counties in Arizona, echoed those movements. A poll of local governments in 15 states by the National League of Cities found that more than 200 small governments turned down pandemic relief funds, a small percentage of the money available to small governments.
The Elko commissioners refused a workforce grant funded by the CDC, money intended to “create, expand, and sustain a public health workforce, including school nurses.” Funding would have flowed through the state to the county, allowing it to hire two dedicated public health services workers for two years.
County workers charged with researching the grant and submitting it to the board said the idea was to conduct a study in those two years that would help them determine how much it would cost to create a local health department or district. health, including neighboring counties. .
Elko County has not had a public health department since budget woes prompted officials to allocate more than 15 years ago.
Adriane Casalotti, chief of government and public affairs for the National Association of County and City Health Officials, said communities across the country have generally been asking for increased funding during the pandemic, which has strained already underfunded public health infrastructure and with insufficient staff.
“That being said,” Casalotti said, “in the last few months, I would say, we’ve heard of a handful of health departments that either wouldn’t apply or couldn’t accept … specific grants,” that include Covid vaccines.
At an Elko County commission meeting in late 2021, then-transit management coordinator Abigail Wheeler presented the grant to the board and a roomful of residents eager to air their grievances about the CDC and decide allegations of federal government overruns, overspending and corruption related to the pandemic response.
Wheeler began by urging county commissioners to keep an open mind.
“I’m very aware that this is basically the worst time that this grant could come out because there’s a lot of public health distaste because of what’s happened with Covid and our whole community, our whole country and around the world ,” she said. “We have been beaten to death, the consequences of the Covid pandemic.”
Wheeler, now the grants and contracts manager for the county, began by reminding commissioners that creating a local health department or district was a goal that predated the pandemic and the polarization it caused.
A 2019 meeting with the state Department of Health and Human Services highlighted the need for more local public health infrastructure.
“They’re thinking about things like tuberculosis and measles and restaurant inspections,” Wheeler said. “They are not thinking about Covid. And they’re saying to themselves, ‘We can’t contact you if you’ve had a TB case. We’re 370 miles from Elko County.’”
Elko is like a landlocked island, Wheeler said during an interview with KHN. Although smaller in population than Clark or Washoe counties in Nevada, Elko covers more than 17,000 square miles, making it the fourth largest county by area in the contiguous US and the second largest in Nevada .
“We have to be our cavalry,” Wheeler said.
Commissioners and community members who opposed the grant said Elko didn’t need more public health resources or a health district or department. They said they were worried about giving up local autonomy and increasing bureaucracy. They also expressed distrust of the CDC.
“You’re 100% factual that the timing couldn’t be worse,” Jon Karr, then chairman of the commission, said during the meeting. Although he said he didn’t buy into all the conspiracy theories about the CDC that others have touted, he added that he doesn’t think CDC officials should be believed.
Commissioner Rex Steninger said he voted against the grant because he feared the commission would be “subservient” to the new entity. “Grants always have strings attached,” he wrote in an emailed response to questions from KHN. “We don’t want CDC forces [sic] reaching Elko County.”
Wheeler pointed to the broken local public health system during the meeting, saying creating a district or health department could help cut red tape and give the county more control over decisions in the hands of state officials. She said it’s clear the county needs more resources, citing the public health response duties she took on in her position as transit manager.
“We’re not public health experts, we’re just people who are willing to step up to the plate and take this on,” Wheeler said, referring to other county employees who helped with the public health response to Covid.
Wheeler was disappointed that the county board rejected the grant opportunity, she told KHN in October. She said she would like to see public health become a county function one day.
Since speaking at the meeting nearly a year ago, Hopkins said she found the mental health services she needed locally. But not everyone is lucky enough to find the help they need close to home, she said. The county’s decision to reject the CDC grant saddens her, she said, but she admits it was the commission’s decision to make.
Other local leaders saw the need for increased public health resources amid the pandemic. The Elko City Council wrote a letter of support for the CDC grant the day before the commission rejected it. “We know for sure it’s not something the city wants to handle on its own,” said Curtis Calder, city manager. “But if our regional partners want to do it as a partnership, we’re willing to help where we can.”
Other rural Nevada counties have partnered with the University of Nevada-Reno School of Medicine to create the Central Nevada Health District, serving four counties and a small city near Reno. “If we don’t step up and help ourselves and our constituents, we can’t complain when the state doesn’t provide what we need or expect,” wrote Dr. JJ Goicoechea, a commissioner in neighboring Eureka County and the interim state. veterinarian, in an email response to KHN.
Casalotti said there are advantages to having local health departments staffed and run by people who live in the community as opposed to a state government hundreds of miles away.
“One of the things we hope people can learn from the pandemic is that you don’t want to build the airplane while flying it,” she said. “At some point, you have to step up because the next crisis is right around the corner.”
But polarization remains an obstacle, Castrucci said.
“This has become a holy war, this has become a war of right and wrong,” he said. “I don’t know how to pass it in a country where we prioritize the health of our nation.”KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Along with Policy Analysis and Survey, KHN is one of the three main operational programs in KFF (Kaiser Family Foundation). KFF is a non-profit organization equipped to provide information on health issues to the nation.
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